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1.
Medicine (Baltimore) ; 100(24): e26332, 2021 Jun 18.
Article in English | MEDLINE | ID: covidwho-1269621

ABSTRACT

BACKGROUND: Patients after breast cancer surgery have a high sense of stigma due to the formation of surgical scars, loss of breast shape or other reasons, leading to anxiety, depression, and other adverse mental health problems, thus reducing their quality of life. Remote peer support intervention based on telephone, internet or email is low-cost and easy to spread, and protects patients' privacy, solves the barriers to access that many patients face when attending face-to-face programs. Therefore, remote peer support may be an effective way to reduce stigma and improve mental health in patients after breast cancer surgery during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Eight databases (PubMed, Embase, Cochrane Library, CNKI, PsycNET, MEDLINE, Psychology & Behavioral Sciences Collection and Web of Science) will be used to select eligible studies that were published from inception to May, 2021. The eligible studies will be screened, extracted and then the methodological quality will be evaluated independently by 2 reviewers. Review manager software version 5.3 software and Stata version 14.0 software will be used for meta-analysis. RESULTS: The results of this study will show the effect of remote peer support on stigma, depression and anxiety in patients after breast cancer surgery during the COVID-19 pandemic and will be submitted to a peer-reviewed journal for publication. CONCLUSION: The results of this study will provide evidence for the effectiveness of remote peer support in patients after breast cancer surgery during the COVID-19 pandemic. PROSPERO REGISTRATION NUMBER: CRD42021255971.


Subject(s)
Breast Neoplasms/psychology , Mastectomy/psychology , Postoperative Complications/therapy , Social Stigma , Social Support , Anxiety/etiology , Anxiety/therapy , Breast Neoplasms/surgery , COVID-19 , Depression/etiology , Depression/therapy , Female , Humans , Meta-Analysis as Topic , Peer Group , Postoperative Complications/etiology , Postoperative Complications/psychology , Research Design , SARS-CoV-2 , Systematic Reviews as Topic , Treatment Outcome
2.
Ann Med Surg (Lond) ; 63: 102151, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1062222

ABSTRACT

BACKGROUND: COVID-19 outbreak has adversely affected care of breast cancer patients world-wide. There is paucity of available data on cancer management in lower-middle income countries during this pandemic, we sought to determine the institutional approach towards management of breast cancer patients and the outcomes during COVID-19 pandemic at our institution. MATERIALS AND METHODS: Clinicopathological and treatment record of cancer patients who presented to the Breast Clinic from 15th March to 31st December 2020 was retrieved from the institutional database for this retrospective clinical observational study. RESULTS: A total of 292 patients were qualified for the analysis in which 206 patients (70.5%) underwent breast cancer surgeries. Only 10 of them (4.9%) were identified to be COVID-19 virus positive on routine pre-operative RT-PCR test before elective surgeries. All were asymptomatic, received home-based care via telecommunication and were operated at a later date when test turned out negative. None of them developed any complications post-operatively. Another group of 86 patients (29.5%) were referred for Neoadjuvant/Systemic chemotherapy in which COVID-19 infection was detected in only 4 patients (4.6%) while receiving cycles. Two patients shown symptoms of cough and fever hence hospitalised but were not candidates for Intensive Care Unit admission while other two patient were asymptomatic and isolated at home. All patients recovered well and chemotherapy was commenced again after negative RT-PCR test. No mortality was observed. CONCLUSION: Despite of being a global crisis particularly for cancer patients we observed infectivity, complications and fatality much lower among breast cancer cases. Further research is needed in this regard including public and private sector hospitals for better understanding behavior of COVID-19 disease and achieve common goal to combat COVID-19 and cancer together.

3.
In Vivo ; 35(1): 635-639, 2021.
Article in English | MEDLINE | ID: covidwho-1011856

ABSTRACT

BACKGROUND/AIM: The perspective validation of a selective approach in patients undergoing breast cancer surgery was performed in order to assess whether patients as well as Health Care Workers (HCWs) were exposed to any undue risk of COVD-19 infection. PATIENTS AND METHODS: From March 9th to June 9th 2020, 207 patients were phone-triaged by a dedicated Breast Care Nurse; a patient-tailored program was adopted with the aim of avoiding hospitalization of SARS-CoV-2 symptomatic patients, with a careful prioritization of surgical procedures according to specific disease features. RESULTS: Two hundred and three out of 207 patients underwent operation; seven patients were temporarily excluded because they tested positive at phone triage (n=3), or in-hospital triage (n=3); another asymptomatic patient with negative NP swab tested IgM Ab-positive so that surgery was re-scheduled two weeks later. Four patients had no surgery; one of them was reconsidered for neoadjuvant chemotherapy (NAC) after testing positive at phone triage; three patients were excluded because they were already hospitalized for COVID-19. Overall, mean in-hospital stay was 2.2 days (±SD, 0.7) and, after hospital discharge, no patient required readmission. CONCLUSION: This preventive program avoided any COVID-19 infection among patients and HCWs, so that an elective breast cancer surgical procedure can be safely and timely pursued without affecting the oncologic outcome.


Subject(s)
Breast Neoplasms/surgery , COVID-19/prevention & control , Health Personnel/statistics & numerical data , Mastectomy/methods , Preventive Health Services/methods , SARS-CoV-2/isolation & purification , Adult , Breast Neoplasms/therapy , COVID-19/epidemiology , COVID-19/virology , Female , Humans , Length of Stay/statistics & numerical data , Medical Oncology/methods , Middle Aged , Pandemics , Reproducibility of Results , SARS-CoV-2/physiology , Triage/methods
4.
Breast ; 55: 1-6, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-969026

ABSTRACT

INTRODUCTION: In order to minimise the risk of breast cancer patients for COVID-19 infection related morbidity and mortality prioritisation of care has utmost importance since the onset of the pandemic. However, COVID-19 related risk in patients undergoing breast cancer surgery has not been studied yet. We evaluated the safety of breast cancer surgery during COVID-19 pandemic in the West of Scotland region. METHODS: A prospective cohort study of patients having breast cancer surgery was carried out in a geographical region during the first eight weeks of the hospital lockdown and outcomes were compared to the regional cancer registry data of pre-COVID-19 patients of the same units (n = 1415). RESULTS: 188 operations were carried out in 179 patients. Tumour size was significantly larger in patients undergoing surgery during hospital lockdown than before (cT3-4: 16.8% vs. 7.4%; p < 0.001; pT2 - pT4: 45.5% vs. 35.6%; p = 0.002). ER negative and HER-2 positive rate was significantly higher during lockdown (ER negative: 41.3% vs. 17%, p < 0.001; HER-2 positive: 23.4% vs. 14.8%; p = 0.004). While breast conservation rate was lower during lockdown (58.6% vs. 65%; p < 0.001), level II oncoplastic conservation was significantly higher in order to reduce mastectomy rate (22.8% vs. 5.6%; p < 0.001). No immediate reconstruction was offered during lockdown. 51.2% had co-morbidity, and 7.8% developed postoperative complications in lockdown. There was no peri-operative COVID-19 infection related morbidity or mortality. CONCLUSION: breast cancer can be safely provided during COVID-19 pandemic in selected patients.


Subject(s)
Breast Neoplasms/surgery , COVID-19/epidemiology , Cross Infection/epidemiology , Mastectomy/methods , Postoperative Complications/epidemiology , Adult , Aged , Aged, 80 and over , Breast Carcinoma In Situ/pathology , Breast Carcinoma In Situ/surgery , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/surgery , Carcinoma, Intraductal, Noninfiltrating/pathology , Carcinoma, Intraductal, Noninfiltrating/surgery , Carcinoma, Lobular/pathology , Carcinoma, Lobular/surgery , Cohort Studies , Female , Humans , Male , Mastectomy/statistics & numerical data , Mastectomy, Segmental/methods , Mastectomy, Segmental/statistics & numerical data , Middle Aged , Neoplasm Staging , Prospective Studies , SARS-CoV-2 , Scotland/epidemiology , State Medicine , Tumor Burden
5.
Anticancer Res ; 40(12): 7119-7125, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-962745

ABSTRACT

BACKGROUND/AIM: Extraordinary restrictions aimed to limit Sars-CoV-2 spreading; they imposed a total reorganization of the health-system. Oncological treatments experienced a significant slowdown. The aim of our multicentric retrospective study was to evaluate screening suspension and surgical treatment delay during COVID-19 and the impact on breast cancer presentation. PATIENTS AND METHODS: All patients who underwent breast surgery from March 11, 2020 to May 30, 2020 were evaluated and considered as the Lockdown group. These patients were compared with similar patients of the previous year, the Pre-Lockdown group. RESULTS: A total of 432 patients were evaluated; n=223 and n=209 in the Lockdown and Pre-lockdown-groups, respectively. At univariate analysis, waiting times, lymph-nodes involvement and cancer grading, showed a statistically significant difference (p<0.05). Multivariate analysis identified waiting-time on list (OR=1.07) as a statistically significant predictive factor of lymph node involvement. CONCLUSION: Although we did not observe a clinically evident difference in breast cancer presentation, we reported an increase in lymph node involvement.


Subject(s)
Breast Neoplasms/epidemiology , COVID-19/epidemiology , Pandemics , SARS-CoV-2/pathogenicity , Adult , Aged , Aged, 80 and over , Axilla/pathology , Axilla/surgery , Breast Neoplasms/complications , Breast Neoplasms/surgery , Breast Neoplasms/virology , COVID-19/complications , COVID-19/virology , Female , Humans , Lymph Node Excision , Lymph Nodes , Lymphatic Metastasis , Mastectomy , Middle Aged , Retrospective Studies , Sentinel Lymph Node Biopsy
6.
Int J Surg Case Rep ; 76: 377-380, 2020.
Article in English | MEDLINE | ID: covidwho-836962

ABSTRACT

INTRODUCTION: Breast cancer management during COVID-19 pandemic has changed and in case of COVID-19 patients with simultaneous neoplasia, it has been strongly recommended to treat Sars-CoV-2 infection firstly. PRESENTATION OF CASE: We reported a case of a 53-years-old women with early breast cancer and simultaneous asymptomatic SARS-CoV-2 infection. According to COVID-19 breast cancer recommendations she underwent hormone neoadjuvant treatment as a bridging therapy for surgery. Six months from the diagnosis, after virus eradication, patient underwent breast surgery. No SARS-CoV-2 RNA was found both in the surgical specimen and sentinel lymph node but micrometastasis were reported. During the last follow-up, the patient was in good clinical condition and started the adjuvant chemotherapy. DISCUSSION: COVID-19 outbreak determined the publication of temporary recommendation leading to an extensive use of neoadjuvant chemotherapy in breast cancer patients. Although endocrine therapy is a mainstay in the adjuvant treatment, its role in the neoadjuvant schedule is unclear. CONCLUSION: Upfront awake surgery should be preferred especially in asymptomatic COVID-19 patient with early breast cancer when monitoring of tumor response is not feasible.

7.
Cureus ; 12(7): e9280, 2020 Jul 19.
Article in English | MEDLINE | ID: covidwho-828137

ABSTRACT

Introduction  The COVID-19 pandemic caused widespread changes in delivery of breast cancer care, aiming to protect vulnerable patients whilst minimising compromise to oncological outcomes. This multicentre observational study aimed to establish early surgical outcomes from breast cancer surgery performed during the peak of the COVID-19 pandemic.  Materials and methods  Data were collected on consecutive patients that underwent breast surgery in four units between 16 March and 24 April 2020. Outcome data at 30 days post-operation were collected, including documented COVID-19 cases in patients and reported cases in healthcare workers directly involved in their care. Recommended modifications to practice to reduce COVID-19 transmission risk, both to patients and healthcare workers in each centre, are described.  Results  A total of 202 patients underwent surgery in four hospitals delivering breast services in the West Yorkshire region over the six-week period at the peak of the pandemic. The age ranged from 28 to 91 years (median 57, interquartile range, 48-65) with 22% having co-morbidities linked to COVID-19, e.g. diabetes or respiratory disease. No patients presented post-operatively with COVID-19 symptoms and at 30 days there had not been any identified COVID-19 cases. There were no unexpected critical care admissions or deaths. One healthcare worker involved in the delivery of breast surgery was diagnosed with COVID-19 during this time and made an uneventful recovery.  Conclusion  Breast cancer surgery, in selected groups and with meticulous adherence to measures designed to reduce COVID-19 transmission, does not appear to be associated with elevated risk to patients or healthcare workers.

8.
Cancer ; 126(20): 4466-4472, 2020 10 15.
Article in English | MEDLINE | ID: covidwho-693298

ABSTRACT

BACKGROUND: The objective of the current study was to provide insight into the effect of coronavirus disease 2019 (COVID-19) on breast cancer screening, breast surgery, and genetics consultations. METHODS: User data from a risk assessment company were collected from February 2 to April 11, 2020. The use of risk assessment was used as a proxy for the use of 3 breast cancer services, namely, breast imaging, breast surgery, and genetics consultation. Changes in the use of these services during the study period were analyzed. RESULTS: All 3 services experienced significant declines after the COVID-19 outbreak. The decline in breast surgery began during the week of March 8, followed by breast imaging and genetics consultation (both of which began during the week of March 15). Breast imaging experienced the most significant reduction, with an average weekly decline of 61.7% and a maximum decline of 94.6%. Breast surgery demonstrated an average weekly decline of 20.5%. When surgical consultation was stratified as breast cancer versus no breast cancer, the decrease among in non-breast cancer patients was more significant than that of patients with breast cancer (a decline of 66.8% vs 11.5% from the pre-COVID average weekly volume for non-breast cancer patients and patients with breast cancer, respectively). During the week of April 5, use of genetics consultations dropped to 39.9% of the average weekly volumes before COVID-19. CONCLUSIONS: COVID-19 has had a significant impact on the number of patients undergoing breast cancer prevention, screening, diagnosis, and treatment.


Subject(s)
Breast Neoplasms/diagnostic imaging , Breast Neoplasms/genetics , Breast Neoplasms/surgery , COVID-19 , Mastectomy/statistics & numerical data , Breast Neoplasms/prevention & control , Female , Genetic Counseling/statistics & numerical data , Humans , Mammography/statistics & numerical data , Risk Assessment , United States/epidemiology
9.
Breast Cancer ; 28(1): 137-144, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-691217

ABSTRACT

INTRODUCTION: COVID-19 is a declared worldwide pandemic. In our country, due to shortage of hospitals and beds in intensive care unit, oncological and breast cancer (BC) resources are temporarily shifted to COVID-19 patients. In addition, risk of cross-infections should be considered in these frail patients. To accomplish more surgical procedures and to reduce the length of hospital stay (LOS), fast track awake BC surgery should be implemented. The aim of the study is to estimate the effects of surgical shift in our facility during the early COVID-19 outbreak. MATERIALS AND METHODS: From 30th January 2020 to 30th of March 2020, 86 consecutive patients were retrospectively enrolled and divided into pre-COVID-19-BC and COVID-19-BC. Clinical parameters and anamnestic data were collected and analyzed. Surgical procedures, relative complications and type of anaesthesia were reported. The effect on surgical time (ST), operative room time (ORT) and length of stay (LOS) were described and examined. RESULTS: No statistical difference was found in complications rate, clinical data and surgical procedures (p > 0.05). Awake breast conservative surgery (BCS) was the most frequent procedure in COVID-19-BC (p = 0.006). A statistically significant decrease in ORT and LOS was reported in COVID-19-BC (p = 0.040 and p = 0.0015 respectively), while comparable time resulted for ST (p = 0.976). Mean ORT and LOS reduction were 20.79 min and 0.57 hospital bed days. CONCLUSION: In the "COVID-19 era", fast track awake breast surgery provides a reduction of ORT, LOS and potentially surgical treatment for a wider number of oncological patients.


Subject(s)
Breast Neoplasms/surgery , COVID-19 , Mastectomy/methods , Aged , Anesthesia/methods , Breast Neoplasms/pathology , COVID-19/prevention & control , Female , Humans , Italy , Length of Stay , Lymph Node Excision , Mastectomy/adverse effects , Mastectomy, Segmental/adverse effects , Mastectomy, Segmental/methods , Middle Aged , Operative Time , Postoperative Complications/etiology , Retrospective Studies , Wakefulness
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